Cell response assay for cancer and methods of producing and using same

ABSTRACT

A cell response assay for cancer is provided. In the assay, the levels of a cancer cell type biomarker, a chemo resistance biomarker and a metastatic potential biomarker are simultaneously measured in a biological sample.

CROSS REFERENCE TO RELATED APPLICATIONS/INCORPORATION BY REFERENCESTATEMENT

The present application is a continuation of U.S. Ser. No. 14/346,638,filed Mar. 21, 2014; which is a U.S. national stage application filedunder 35 USC §371 of international application No. PCT/US12/56668, filedSep. 21, 2012; which claims priority to U.S. Ser. No. 61/538,302, filedSep. 23, 2011. The entire contents of each of the above-referencedpatent applications are hereby expressly incorporated by reference.

STATEMENT REGARDING FEDERALLY SPONSORED RESEARCH OR DEVELOPMENT

Not Applicable.

BACKGROUND

1. Technical Field

The presently disclosed and/or claimed inventive concept(s) generallyrelates to cellular assays. More particularly, but not by way oflimitation, the presently disclosed and/or claimed inventive concept(s)relates to methods of assaying biological samples to determine thecellular response to treatment/therapy and/or monitor progression of adisease state.

2. Description of the Background Art

Affinity assays using fluorescence compounds are commonly used for celland tissue analysis for biomarkers. The fluorescent compounds (labels)are attached (conjugated) to affinity molecules. Said affinity moleculesmay be, for example but not by way of limitation, antibodies, antigens,nucleic acid or other molecules that associate with the biomarkers ofinterest. This direct affinity method is a commonly used method to staincells and tissues (See Horan andhttp://www.crm.ed.ac.uk/facilities/flow-cytometry/protocols/immunofluorescence-staining).The cells or tissues are incubated with conjugates, and unboundmaterials are washed away from cell bound materials. The conjugates areread cytometrically with a flow cytometer, scanning microscope or otherdevice capable of detecting the fluorescence emission of the cellularmaterial (see for example, US2008/0187198; Krivacic, 2004; andHerzenberg, 2002). Protocols vary and may or may not require cell ortissue fixation, depending on the conjugate used.

In practice, cell counts are measured using flow cytometry or scanningmicroscopy technologies which capture signals of cells at the excitationand emission wavelengths required to detect the dye. Differentconjugates can be simultaneously determined (multiplexed) by usingfluorescent dyes with distinct excitation wavelengths and emissionwavelengths. Multiplexing of fluorescence signals is commonly used todetect as many properties as possible at one time. For example,biomarkers conjugated to phycoerythrin (ex 592, em 614 nm) can bemeasured independent from biomarkers conjugated tofluorescein-5-isothiocyanate (FITC) (ex 488, em 525 nm) using differentexcitation and emission filters. A list of known fluorophores iscommonly available to researchers in the field (seehttp://www.fluorophores.org/).

Cell and tissue assays are typically performed for various types ofcancer assays. Both cell and tissue assays use affinity reagents todetect biomarkers on or inside the cell, such as peptides, proteins,nucleic acid and modifications thereof (see, for example, Punnoose,2010). Nucleic acids are measured as messenger RNA, Micro RNA and/or DNAprior to or after PCR amplification. Antibodies are also used fordetecting protein biomarkers such as, but not limited to, EGFR, IGFRE,ERBB2, PSA, PL2L, kRAS, EPCAM, CK, and CD. A variety of tumor markershave detected breast, colon, prostate and melanoma cancer cells (see,for example, Mocellin, 2006). The use of biomarkers for monitoringcancer progression and/or treatment is also common practice. Forexample, the use of the plasminogen activator system (uPA) is monitoredby measuring uPA, the plasminogen inhibitor PAI-1, and the complex ofboth (see Carney et al., 2009).

Cell assays are often looking for rare but clinically significantevents. For example, circulating tumor cells (CTC) are significant at 5cancer cells in 80,000,000 normal blood cells. The CTC must be isolatedby enrichment or depletion to eliminate interference from normal cells(see, for example, Pantel et al., 2008). The isolated rare cells ofinterest then have to be assayed by methods that can detect eachindividual cell. Additionally the biomarkers expressed on these cellscan be as low as 100 molecules per cell. Overall high sensitivitydetection methods are required.

The sensitivity of traditional fluorescent labels for detectingbiomarkers is generally poor for rare cell analysis. Excess affinitymolecules must be used to increase the number of probes associated withthe cell or tissue. This problem can be overcome partially using enzymesto catalytically increase the number of fluorescent labels. For example,Tyramide Signal Amplification (TSA) uses peroxidase enzyme to catalyzethe deposition of multiple fluorophores on tyrosines of proteins byformation of tyramide with phenolic labeled fluorophores. The enzyme isassociated with an affinity label to direct which cells are reacted(see, for example, Bobrow et al., 1993). However, enzymaticamplification involves multiple lengthy steps that increase thedifficulty of the measurements.

Nanoparticles can be used to increase the number of fluorescent labels.However, multiple affinity molecules must also be attached to thenanoparticles, and adsorption of organic compounds onto nanoparticlesalso decreases the fluorescence signals. As a result, the nanoparticleswith fluorescent labels (such as FITC) are no more sensitive thandirectly conjugated fluorescent labels. Additional problems withnanoparticles are that the size and coating must be carefully controlledfor the particles to cross the cell walls (see, for example, Goodman etal., 2007).

Rare earth elements, like europium (Eu), when chelated, or in oxides orsilicate lattices, have fluorescent or luminescent behaviors that allowdetection thereof in a method with high sensitivity. These phosphorshave been used as high sensitivity signals for detection of material.For example, Ryan et al. (1973) first explained the use of rare-earthmetal activated phosphors to detect explosive material. Nanoparticlescontaining the europium phosphor can be fluorescent in a 500 to 700 nmrange and thus can be useful as a tracer for explosives.

Chelation of europium is critical to stability and strength of thefluorescence signal. Europium has long been shown to form a strongchelate with beta diketones. Shepard and Serigne (1934) have shownthenoyltriflouracetone (TTA) has an association constant (log Ka) of 8.0when converted to enolate. Stary (1959) demonstrated that benzoylacetone(HBA) has a log K of 18.9. Haar and Umland (1962) showed8-hyroxyquinoline (oxine) forms an oxinate with europium. Dyrssen (1956)describes Beta-isopropyltropolone (HIPT) log K-6.24 dissociationconstant. Eu2+ resembles Ba2+ and can be complexed by various amine polycarboxylate ions such as DTPA (log Ka 23), DCTA (log Ka 19), EDTA (logKa 17), HEDTA (log Ka 15), HTA (log Ka 11), and IMDA (log Ka 6).Matsumoto et al. (2007) demonstrated that europium with a variety ofchelates in silicate nanoparticles can be a fluorophor in the range of500 to 700 nm. Ullman et al. (1994) and Kraus et al. (2001) demonstrateeuropium with a variety of chelates in polystyrene nanoparticles. Inparticular,N,N,N′,N′-{2,6-bis(3′-aminomethyl-1″-pyrazolyl)-4-phenylpyridine} tetrakis (acetic acid) (BBTA) and 3-(2-thienoyl)-1,1,1-trifluoroacetone (TTA)are useful. In general, a wide variety of compounds has been shown tocomplex with lanthanide elements (for example but not by way oflimitation, europium (Eu)), and this complex provides stability andstrength to the fluorescence signals.

In practice, rare earth metal labels (such as but not limited to,lanthanides like Eu, Sm, Tm, Pr) or others like Tb have been applied ashigh sensitivity fluorescents or luminescent detection technology innanoparticles (Ullman et al. 1994; Kraus et al., 2001; and Harma et al.,2001). These labels have been applied to various analytical methods forclinical diagnostics using nanoparticles. Ullman et al. demonstratedthat nanoparticles containing europium chelate were useful indiagnostics as biomarker labels that generate luminance. Kraus et al.also showed nanoparticles with Europium chelate (such as but not limitedto Eu TTA3) were detectable above 500 nm and useful as diagnostic labelsfor biomarkers. Harma et al. showed the advantages of time resolvedfluorescence using europium-label detection technology. In generaleuropium fluorescence is either an acceptable high sensitivity labelwhen the signal is used directly or amplified with subsequent reactions.

Another type of fluorescent label is a molecule which binds directly tothe biomarker or a probe. These labels do not need affinity molecules.For example, 4′,6-diamidino-2′-phenylindole, dihydrochloride (DAPI) is aprobe that fluoresces blue (455 nm) when bound to double stranded DNAand excited by exposure to light at 345 nm (see, for example, Morikawaet al., 1981). The detection of DNA in cells is an indication of aliving cell nucleus. Other probes containing bis(zinc2+dipicolylamine)groups bind to surfaces enriched with anionic phospholipids, especiallyphosphatidylserine (PS) exposed on cell membranes (see, for example,U.S. Pat. No. 7,179,616). The appearance of phosphatidylserine (PS) onthe cell surface indicates cell apoptosis, prior to DNA fragmentation,morphological changes, and plasma membrane permeabilization.

Overall it is known that cell and tissue assays can be done by affinityassays whether using affinity reagents with fluorescent labels orfluorescent probes. It is also known that these signals can bemultiplexed, and high sensitivity labels and probes are needed to detectrare events. Further, it is known that biomarkers can be selected forassay applications in the field of cancer.

Cell and tissues assays in the field of cancer are used to directtreatment. With the entry of more antibody-based chemotherapies, apatient's cancer must be typed to assure the cancer antigen is present(personalized medicine). The number of ever increasing cancer antigensis becoming increasingly complex (see, for example, Cheever et al.,2009). As a result, the selection of biomarkers to test is a difficultchoice; the expression level, number of epitopes, expression on cancerstem cells, cellular location of expression, and the number of patientswith antigen positive cancers all must be considered. Antigens withtherapeutic function, immunogenicity (T cell expression), oncogenicity(association with the oncogenic process) and specificity rank highest invalue. Even with a ranking, selection is not straight forward and is inneed of a simplification; picking the wrong antigen for a patient isstill likely, and all antigens cannot be measured at one time.

Chemo resistance is another important parameter that cell and tissueassays try to address by measuring cells and tissue during the treatmentcourse to determine if cancer antigens are still present. Another methodfor determining chemo resistance is to culture or grow the cancer cellsand see if the cancer antigens are expressed by living cells (see, forexample, the so called EPISPOT method of Alix-anabieres et al., 2009).Another method is to measure the cancer stem cell antigens as a measureof chemo resistance (see for example, Pardal et al., 2003; and Gao etal., 2010). However, all three of these methods also rely on “picking”the right antigen and fail to give good information for all patients.

Thus the current field lacks a comprehensive measure of the metastaticpotential of a cancer cell/tissue. The presently disclosed and/orclaimed inventive concept(s) provide a cell based response assay thatovercomes the defects and disadvantages of the prior art.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 graphically depicts a cell response assay constructed inaccordance with the presently disclosed and/or claimed inventiveconcept(s).

DETAILED DESCRIPTION

Before explaining at least one embodiment of the inventive concept(s) indetail by way of exemplary drawings, experimentation, results, andlaboratory procedures, it is to be understood that the inventiveconcept(s) is not limited in its application to the details ofconstruction and the arrangement of the components set forth in thefollowing description or illustrated in the drawings, experimentationand/or results. The inventive concept(s) is capable of other embodimentsor of being practiced or carried out in various ways. As such, thelanguage used herein is intended to be given the broadest possible scopeand meaning; and the embodiments are meant to be exemplary—notexhaustive. Also, it is to be understood that the phraseology andterminology employed herein is for the purpose of description and shouldnot be regarded as limiting.

Unless otherwise defined herein, scientific and technical terms used inconnection with the presently disclosed and/or claimed inventiveconcept(s) shall have the meanings that are commonly understood by thoseof ordinary skill in the art. Further, unless otherwise required bycontext, singular terms shall include pluralities and plural terms shallinclude the singular. Generally, nomenclatures utilized in connectionwith, and techniques of, cell and tissue culture, molecular biology, andprotein and oligo- or polynucleotide chemistry and hybridizationdescribed herein are those well known and commonly used in the art.Standard techniques are used for recombinant DNA, oligonucleotidesynthesis, and tissue culture and transformation (e.g., electroporation,lipofection). Enzymatic reactions and purification techniques areperformed according to manufacturer's specifications or as commonlyaccomplished in the art or as described herein. The foregoing techniquesand procedures are generally performed according to conventional methodswell known in the art and as described in various general and morespecific references that are cited and discussed throughout the presentspecification. See e.g., Sambrook et al. Molecular Cloning: A LaboratoryManual (2nd ed., Cold Spring Harbor Laboratory Press, Cold SpringHarbor, N.Y. (1989) and Coligan et al. Current Protocols in Immunology(Current Protocols, Wiley Interscience (1994)), which are incorporatedherein by reference. The nomenclatures utilized in connection with, andthe laboratory procedures and techniques of, analytical chemistry,synthetic organic chemistry, and medicinal and pharmaceutical chemistrydescribed herein are those well known and commonly used in the art.Standard techniques are used for chemical syntheses, chemical analyses,pharmaceutical preparation, formulation, and delivery, and treatment ofpatients.

All patents, published patent applications and non-patent publicationsmentioned in the specification are indicative of the level of skill ofthose skilled in the art to which this presently disclosed and/orclaimed inventive concept(s) pertains. All patents, published patentapplications and non-patent publications referenced in any portion ofthis application are herein expressly incorporated by reference in theirentirety to the same extent as if each individual patent or publicationwas specifically and individually indicated to be incorporated byreference.

All of the compositions and/or methods disclosed and claimed herein canbe made and executed without undue experimentation in light of thepresent disclosure. While the compositions and methods of this presentlydisclosed and/or claimed inventive concept(s) have been described interms of preferred (but non-limiting) embodiments, it will be apparentto those of skill in the art that variations may be applied to thecompositions and/or methods and in the steps or in the sequence of stepsof the method described herein without departing from the concept,spirit and scope of the presently disclosed and/or claimed inventiveconcept(s). All such similar substitutes and modifications apparent tothose skilled in the art are deemed to be within the spirit, scope andconcept of the inventive concept(s) as defined by the appended claims.

As utilized in accordance with the present disclosure, the followingterms, unless otherwise indicated, shall be understood to have thefollowing meanings:

The use of the word “a” or “an” when used in conjunction with the term“comprising” in the claims and/or the specification may mean “one,” butit is also consistent with the meaning of “one or more,” “at least one,”and “one or more than one.” The use of the term “or” in the claims isused to mean “and/or” unless explicitly indicated to refer toalternatives only or the alternatives are mutually exclusive, althoughthe disclosure supports a definition that refers to only alternativesand “and/or.” Throughout this application, the term “about” is used toindicate that a value includes the inherent variation of error for thedevice, the method being employed to determine the value, or thevariation that exists among the study subjects. The use of the term “atleast one” will be understood to include one as well as any quantitymore than one, including but not limited to, 2, 3, 4, 5, 10, 15, 20, 30,40, 50, 100, etc. The term “at least one” may extend up to 100 or 1000or more, depending on the term to which it is attached; in addition, thequantities of 100/1000 are not to be considered limiting, as higherlimits may also produce satisfactory results.

The term “about” is used to indicate that a value includes the inherentvariation of error for the device, the method being employed todetermine the value and/or the variation that exists among studysubjects.

As used in this specification and claim(s), the words “comprising” (andany form of comprising, such as “comprise” and “comprises”), “having”(and any form of having, such as “have” and “has”), “including” (and anyform of including, such as “includes” and “include”) or “containing”(and any form of containing, such as “contains” and “contain”) areinclusive or open-ended and do not exclude additional, unrecitedelements or method steps.

The term “or combinations thereof” as used herein refers to allpermutations and combinations of the listed items preceding the term.For example, “A, B, C, or combinations thereof” is intended to includeat least one of: A, B, C, AB, AC, BC, or ABC, and if order is importantin a particular context, also BA, CA, CB, CBA, BCA, ACB, BAC, or CAB.Continuing with this example, expressly included are combinations thatcontain repeats of one or more item or term, such as BB, AAA, MB, BBC,AAABCCCC, CBBAAA, CABABB, and so forth. The skilled artisan willunderstand that typically there is no limit on the number of items orterms in any combination, unless otherwise apparent from the context.

The term “probe” as used herein will be understood to refer to any typeof affinity reagent that binds to a specific biomarker as describedherein. Examples of probes include, but are not limited to, antibodies(or binding fragments or derivatives thereof), receptors, organicmolecules, inorganic molecules, ligands, nucleic acids (including butnot limited to, DNA, RNA, microRNA, mRNA, siRNA, etc.), peptides,polypeptides, proteins, epitopes, antigens, ligands, receptors,complexes, lipids, glycoproteins, glycolipids, glycosaminoglycans,carbohydrates, polycarbohydrates, glycoconjugates, and any combinationor derivative thereof.

The term “biomarker” as used herein will be understood to refer to anytarget site on the surface of or inside of a cell that a probe can haveaffinity therefor and thus can bind to said moiety. The “biomarker” maybe, for example but not by way of limitation, a nucleic acid, peptide,polypeptide, protein, epitope, antigen, ligand, receptor, complex (i.e.,an MHC-peptide complex), lipid, glycoprotein, glycolipid,glycosaminoglycan, carbohydrate, polycarbohydrate, glycoconjugate, andany combination or derivative thereof.

The terms “peptide”, “polypeptide” and “protein” are used herein torefer to a polymer of amino acid residues. The term “polypeptide” asused herein is a generic term to refer to native protein, proteinfragments, or analogs of a polypeptide sequence. Hence, native protein,protein fragments, and analogs are species of the polypeptide genus.

The terms “polynucleotide”, and “nucleic acid” are used interchangeably.They refer to a polymeric form of nucleotides of any length, eitherdeoxyribonucleotides or ribonucleotides, or analogs thereof. Thefollowing are non-limiting examples of polynucleotides: coding ornon-coding regions of a gene or gene fragment, loci (locus) defined fromlinkage analysis, exons, introns, messenger RNA (mRNA), transfer RNA,ribosomal RNA, ribozymes, cDNA, recombinant polynucleotides, branchedpolynucleotides, plasmids, vectors, isolated DNA of any sequence,isolated RNA of any sequence, nucleic acid probes, and primers. Apolynucleotide may comprise modified nucleotides, such as methylatednucleotides and nucleotide analogs. If present, modifications to thenucleotide structure may be imparted before or after assembly of thepolymer. The sequence of nucleotides may be interrupted bynon-nucleotide components. A polynucleotide may be further modified,such as by conjugation with a labeling component. The terms “isolatednucleic acid” and “isolated polynucleotide” are used interchangeably; anucleic acid or polynucleotide is considered “isolated” if it: (1) isnot associated with all or a portion of a polynucleotide in which the“isolated polynucleotide” is found in nature, (2) is linked to apolynucleotide to which it is not linked in nature, or (3) does notoccur in nature as part of a larger sequence.

The term “antibody” is used in the broadest sense, and specificallycovers monoclonal antibodies (including full length monoclonalantibodies), polyclonal antibodies, multispecific antibodies (e.g.,bispecific antibodies), and antibody fragments so long as they exhibitthe desired biological activity. Thus, the terms “Antibody” or “antibodypeptide(s)” refer to a full length immunoglobulin molecule (i.e., anintact antibody), or a binding fragment thereof that competes with theintact antibody for specific antigen binding. Binding fragments may beproduced by recombinant DNA techniques, or by enzymatic or chemicalcleavage of intact antibodies. Binding fragments include Fab, Fab',F(ab')2, Fv, scFv, disulfide linked Fv, Fd, diabodies, single-chainantibodies, single domain antibodies (such as but not limited to,NANOBODIES®) and other antibody fragments that retain at least a portionof the variable region of an intact antibody. See, e.g., Hudson et al.(Nature Med., 9:129-134 (2003)).

The term “antigen binding fragment” or “antigen-binding portion” of anantibody, as used herein, refers to one or more fragments of an antibodythat retain the ability to bind to an antigen. The antigen-bindingfunction of an antibody can be performed by fragments of an intactantibody. Examples of binding fragments encompassed within the term“antigen-binding fragment” of an antibody include but are not limitedto, Fab, Fab', F(ab')2, Fv, scFv, disulfide linked Fv, Fd, diabodies,single-chain antibodies, single domain antibodies (such as but notlimited to, NANOBODIES®, isolated CDRH3, and other antibody fragmentsthat retain at least a portion of the variable region of an intactantibody. These antibody fragments are obtained using conventionalrecombinant and/or enzymatic techniques and are screened for antigenbinding in the same manner as intact antibodies.

The term “epitope” includes any protein determinant capable of specificbinding to an immunoglobulin or T-cell receptor. In certain embodiments,an epitope is a region of an antigen that is specifically bound by anantibody. Epitopic determinants usually include chemically activesurface groupings of molecules such as amino acids, sugar side chains,phosphoryl, or sulfonyl groups. In certain embodiments, an epitope mayhave specific three dimensional structural characteristics (e.g., a“conformational epitope”), as well as specific charge characteristics.

The term “nanoparticle” as used herein refers to a particle havingdimensions of from about 1 to about 5000 nanometers, and having anysize, shape or morphology. The nanoparticles utilized in accordance withthe presently disclosed and/or claimed inventive concept(s) may benaturally occurring, commercially available nanoparticles, or thenanoparticles may be synthesized for use in accordance with thepresently disclosed and/or claimed inventive concept(s), as describedherein below and as known in the art. Particular examples ofnanoparticles that may be utilized in accordance with the presentlydisclosed and/or claimed inventive concept(s) include, but are notlimited to, poly(lactic-co-glycolic) acid (PLGA) nanoparticles, polylactic acid (PLA) nanoparticles, Chitosen nanoparticles, liposomes, andderivatives or combinations thereof.

As used herein, the terms “label” or “labeled” refers to incorporationof a detectable marker, e.g., by attachment of a fluorescent, enzymaticor colorimetric label or incorporation of a radiolabeled amino acid.Various methods of labeling polypeptides and glycoproteins are known inthe art and may be used. Examples of labels for polypeptides include,but are not limited to, the following: radioisotopes or radionuclides(e.g., 3H, 14C, 15N, 35S, 90Y, 99Tc, 111In, 1251, 1311), fluorescentlabels (e.g., FITC, rhodamine, lanthanide phosphors), enzymatic labels(e.g., horseradish peroxidase, (3-galactosidase, luciferase, alkalinephosphatase), chemiluminescent, biotinyl groups, predeterminedpolypeptide epitopes recognized by a secondary reporter (e.g., leucinezipper pair sequences, binding sites for secondary antibodies, metalbinding domains, epitope tags). In some embodiments, labels are attachedby spacer arms of various lengths to reduce potential steric hindrance.

The terms “label”, “detectable marker” and “detection moiety” are usedinterchangeably herein.

A fluorophore may be employed in the methods of the presently disclosedand/or claimed inventive concept(s) and detected via any of numerouscolorimetric and fluorescence detection methods. Depending on theapplication and purpose, such methods include, but are not limited to,absorbance spectroscopy, fluorescence spectroscopy, fluorescenceactivated cytometry (FACS), fluorescence microscopy, fluorescenceresonance energy transfer (FRET), and the like.

Various types of fluorophores, depending on the application and purpose,may be employed in accordance with the presently disclosed and/orclaimed inventive concept(s). Examples of suitable fluorophores aredescribed herein below. Examples of suitable fluorophores are describedherein below. Other examples are given in U.S. Pat. Nos. 7,465,747 and7,955,859, issued to Matsumoto et al. on Dec. 16, 2008 and Jun. 7, 2011,respectively; and U.S. Publication No. US2007/0026407, published Feb. 1,2007 (the entire contents of which are expressly incorporated herein byreference in their entirety).

Ample guidance regarding fluorophore selection, methods of linkingfluorophores to various types of molecules, and methods of use thereofis available in the literature of the art [for example, refer to:Richard P. Haugland, “Molecular Probes: Handbook of Fluorescent Probesand Research Chemicals 1992-1994”, 5th ed., Molecular Probes, Inc.(1994); U.S. Pat. No. 6,037,137 to Oncoimmunin Inc.; Hermanson,“Bioconjugate Techniques”, Academic Press New York, N.Y. (1995); Kay M.et al., 1995. Biochemistry 34:293; Stubbs et al., 1996. Biochemistry35:937; Gakamsky D. et al., “Evaluating Receptor Stoichiometry byFluorescence Resonance Energy Transfer,” in “Receptors: A PracticalApproach,” 2nd ed., Stanford C. and Horton R. (eds.), Oxford UniversityPress, UK. (2001); U.S. Pat. No. 6,350,466 to Targesome, Inc.].Therefore, no further description is considered necessary.

The terms “substantial increase” and “substantial decrease”, as well asgrammatical equivalents thereof, will be understood herein to refer toat least a 12% increase or decrease, such as at least a 30% increase ordecrease, at least a 50% increase or decrease, at least a 75% increaseor decrease, or at least a 90% increase or decrease.

The terms “cancer” and “cancerous” refer to or describe thephysiological condition in mammals that is typically characterized byunregulated cell growth. Examples of cancer include but are not limitedto, carcinoma, lymphoma, blastoma, and sarcoma. More particular examplesof such cancers include squamous cell cancer, small-cell lung cancer,non-small cell lung cancer, gastrointestinal cancer, pancreatic cancer,glioblastoma, cervical cancer, ovarian cancer, liver cancer, bladdercancer, hepatoma, breast cancer, colon cancer, colorectal cancer,endometrial carcinoma, salivary gland carcinoma, kidney cancer, renalcancer, prostate cancer, vulval cancer, thyroid cancer, hepaticcarcinoma and various types of head and neck cancer.

The term “metastasis” as used herein will be understood to refer to thespread of cancer from a primary tumor to other parts of the body.Metastasis is a sequential, multistep process in which tumor cellsdetach from a primary tumor, migrate through the basement membrane andextracellular matrix, and invade the lymphatic and/or blood systems.This is followed by the establishment of secondary tumors at distantsites.

“Mammal” for purposes of treatment refers to any animal classified as amammal, including human, domestic and farm animals, nonhuman primates,and zoo, sports, or pet animals, such as dogs, horses, cats, cows, etc.

The term “patient” includes human and veterinary subjects. In certainembodiments, a patient is a mammal. In certain other embodiments, thepatient is a human.

The term “biological sample” as used herein will be understood to referto a sample of biological fluid. Biological samples include, but are notlimited to, blood, plasma, serum, sputum, cerebrospinal fluid (CSF),tears, mucus, urine, tissue, other types of specimens, and the like.

The phrase “providing a biological sample” as used herein refers toobtaining a biological sample for use in methods described and claimedherein. Most often, this will be done by removing a sample of cells froman animal, but can also be accomplished by using previously isolatedcells (e.g., isolated by another person, at another time and/or foranother purpose). The step of “providing a biological sample” mayfurther include various isolation and/or purification steps known in theart for providing a specific component of a biological sample for use inthe methods described and claimed herein.

Numerous aspects and advantages of the inventive concept(s) will beapparent to those skilled in the art upon consideration of the followingdetailed description which provides illumination of the practice of thepresently disclosed and/or claimed inventive concept(s).

The presently disclosed and/or claimed inventive concept(s) generallyrelates to multiplexed direct affinity conjugate assays of cells usingprobes able to determine a cellular response to treatments; this type ofassay is herein termed a “cell response assay”.

The presently disclosed and/or claimed inventive concept(s) generallyrelates to the use of a combination of biomarkers for cancer cell/tissuetype, metastatic potential and chemo resistance in a multiplexedaffinity assay for cancer cells and tissue. Fluorescent labels eitherconjugated to affinity molecules/reagents or capable of directly bindingto the biomarker are used and are referred to herein as labeled probes.This combination of labeled probes for biomarkers allows determinationof the cellular response to treatments by simultaneously measuring celltype, chemo resistance nature, and metastatic potential and/or cellviability, and allows simple multiplexed signals with high sensitivity.

Surprisingly, the biomarker affinity markers selected in this ordersolves the problem of “picking” the right antigen for cancer antigentype and also provides accurate information on the response to therapy.More particularly, the presently disclosed and/or claimed inventiveconcept(s) relates to methods of using said affinity molecules andmolecular probes as compositions, dosage forms, and kits.

The presently disclosed and/or claimed inventive concept(s) combinescell biomarker(s) for tissue type with biomarker(s) for metastaticpotential and biomarker(s) for cell viability in an affinity assay forcancer cells and tissue. In FIG. 1, the biomarker for cancer cell typeis represented as biomarker A and is always present in the diseasestate. The biomarker for metastatic potential is represented asbiomarker B and is present in the disease state with metastaticinvasiveness potential. The biomarker for chemo resistance isrepresented as biomarker C and is present in unresponsive cells.Fluorescent labels either conjugated to the affinity reagents or capableof directly binding the biomarker are used to simultaneously detectbiomarkers A, B and C; simultaneous detection is obtained by usingfluorescent labels that are detectable at different excitations and/oremission wavelengths.

The desired response to the treatment would be first for the number ofcancer cells to decrease overall. However, the unexpected responseidentified by the presently disclosed and/or claimed inventiveconcept(s) is for biomarker B (i.e., metastatic potential) to increaseor become present in the course of treatment in a greater proportion ofcancer cells detected by biomarker A, and for biomarker C (i.e. chemoresistance) to decrease or become absent in the course of treatment in agreater proportion of cancer cells detected by biomarker A. In order forthis combination of cell biomarkers to correctly predict the response,the biomarker for tissue type, metastatic potential and cell viabilitymust be biochemically linked in a process. Biomarkers A, B and C mustco-exist in the disease state and be fundamental to progression orrelapse of the disease. Further, the presence of biomarkers B and C mustbe linked such that the presence of one facilitates the absence of theother. This combination of biomarkers allows the determination of thecell response to treatments; by simultaneously measuring cell type,chemo resistance nature, and metastatic potential (and possibly alsocell viability), the “cell based response assay” can accurately monitorcancer treatment and/or monitor disease progression/relapse.

Turning now to the particular embodiments of the presently disclosedand/or claimed inventive concept(s), one embodiment thereof is directedto a multiplexed assay for cancer. Said assay involves simultaneouslymeasuring: (1) at least one cancer cell type biomarker (also referred toherein as Biomarker A) in a biological sample of a cancer patientutilizing a first labeled probe that binds to said cancer cell typebiomarker; (2) at least one chemo resistance biomarker (also referred toherein as Biomarker C) in the biological sample utilizing a secondlabeled probe that binds to said chemo resistance biomarker; and (3) atleast one metastatic potential biomarker (also referred to herein asBiomarker B) in the biological sample utilizing a third labeled probethat binds to said metastatic potential biomarker. The at least threelabeled probes are measured at different excitations and emissionwavelengths.

The assays/methods described herein may be utilized for a specificcancer, or the assays/methods may be general assays for all types ofcancers. Likewise, the cancer cell type biomarker utilized in accordancewith the presently disclosed and/or claimed inventive concept(s) may bea non-specific cancer cell biomarker, or may be specific for a certaintype of cancer. Examples of cancers that may be detected/monitored bythe currently disclosed and/or claimed inventive concept(s) include, butare not limited to, lung, bronchus, colon, rectum, pancreas, prostate,breast, liver, bile duct, bladder, ovary, brain, central nervous system(CNS), kidney, pelvis, uterine corpus, oral cavity or pharynx ormelanoma cancers.

Non-limiting examples of non-specific cancer cell type biomarkersinclude, but are not limited to, cytokeratins (CK), EpCAM, N-cadherin,E-cadherin and vimentin.

For example but not by way of limitation, the carcinoma cells may beindicated by cytokeratin (CK) as a biomarker A, and the first labeledprobe may comprise multiple labeled antibodies for separate cytokeratins(such as but not limited to, cytokeratins 8/18/19. Cytokeratins (CK) areproteins of keratin-containing intermediate filaments found in theintracytoplasmic cytoskeleton of epithelial tissue and refer to a familyof fibrous structural proteins. There are two fundamental types ofcytokeratins: the acidic type I cytokeratins and the basic or neutraltype II cytokeratins. Cytokeratins are usually found in pairs comprisinga type I cytokeratin and a type II cytokeratin. Basic or neutralcytokeratins include (but are not limited to) CK1, CK2, CK3, CK4, CK5,CK6, CK7, CK8 and CK9. Acidic cytokeratins include (but are not limitedto) CK10, CK12, CK 13, CK14, CK16, CK17, CK18, CK19 and CK20.

In other instances the, Epithelial cell adhesion molecule (EpCAM) is aprotein that signifies the presence of epithelial cells in a carcinoma.EpCAM has also been designated as TACSTD1 (tumor-associated calciumsignal transducer 1) and CD326 (cluster of differentiation 326). Thus,the terms “EpCAM”, “TACSTD1” and “CD326” are used hereininterchangeably.

In other instances, some cancer cells undergo an Epithelial toMesenchymal transition (EMT) that may be indicated by an increase incancer cell biomarkers such as but not limited to, Vimentin andGalectin-3, which signify cells with a loss of anchorage. Alternatively,certain other cancer cells undergo a Mesenchymal to Epithelialtransition (MET) indicated by an increase in cancer cell biomarkers suchas but not limited to, N-Cadherin, and E-Cadherin. The EMT and METstages for cancer cells signify a change in sub type of cells. It isimportant to detect as many cancer cells as possible and to additionallyknow their sub types to measure the entire tumorigenicity.

The term “cancer cell type biomarker” also includes markers thatidentify specific genetic mutations that cause oncoproteins or oncogenesto be regulated (whether tumor promoting or tumor suppressing). Thesetypes of cancer cell type biomarkers may be utilized alone or incombination with any of the other cancer cell type biomarkers describedherein above. Examples of these types of cancer cell type biomarkersinclude, but are not limited to, HER2/neu, VEGF-165, KRAS, EGFr, WAF,BAX-1, PDGF, Rb, Jagged 1, Notch, VEGF, VEGHR, k-Ras, CAIX, MIB1, MDM,PR, ER, SEL5, SEM1, P13K, Akt2, twist 1, EML-4, ALK, Braf, DRAFF, c-met,and combinations thereof. These oncoproteins and oncogenes are used todirect targeted therapies based on their presence in/on cells. Forexample, the presence of HER2/neu is used to prescribe Herceptintherapy; however, HER2/neu, as with other oncoprotein/oncogene markers,is often only expressed on a fraction of cancer cells, and not allpatients have the specific genetic mutation leading to the biomarker.HER2/neu-positive expression is present in only 10-20% of breast cancerpatients, and even in the HER2/neu-positive patients, the marker is onlypresent in approximately 30% of their circulating tumor cells. Thereforethese markers are often measured in combination with another cancer celltype biomarker.

In other instances, the carcinoma cells may be indicated by a tissuespecific marker. For example, Prostate-Specific Antigen (PSA) is aprotein that signifies the presence of cells of the prostate gland.Non-limiting examples of specific cancer cell type biomarkers include,but are not limited to: prostate specific antigen (PSA) or prostatespecific membrane antigen (PSMA) can be used to detect prostate cancercells; MUC1, CA 15-3 and CA 27-29 can be used to detect breast cancercells; Carcinoembryonic Antigen (CEA), CA19-9 or Galactosyl TransferaseII can be used to detect colon cancer cells; MSLN (mesothelin) can beused to detect pancreatic cancer cells; CA 125 or Follicle-StimulatingHormone (FSH) receptor can be used to detect ovarian cancer cells;Alpha-Fetoprotein can be used to detect liver cancer cells; Melan-A(MLANA), Tyrosinase (TYR), CSPG4, or MITF can be used to detect melanomacancer cells; and Parathyoid related protein (PTHP) or TSHR can be usedto detect thyroid cancer cells.

Any metastatic potential biomarkers known in the art or otherwisecontemplated herein may be utilized in accordance with the presentlydisclosed and/or claimed inventive concept(s). The third labeled probemay be any probe capable of detecting said metastatic potentialbiomarker; for example but not by way of limitation, the third labeledprobe may be one or more labeled antibodies against any of the markersof tumor cell invasiveness listed below. In some instances, themetastatic potential biomarker may be measured as a ratio of one of thebelow-listed biomarkers to the cancer cell type biomarker. Particularnon-limiting examples of biomarkers of metastatic potential that may beutilized in accordance with the presently disclosed and/or claimedinventive concept(s) include a marker(s) of tumor cell invasivenesswhere the marker measures cancer cell invasion into the extracellularmembrane through proteolytic events, such as urokinase plasminogenactivator (uPA), plasminogen activator inhibitor (PAI-1), CD95, serineproteases such as plasmin, ADAM, and others; serine protease inhibitorssuch as Bikunin; matrix metalloproteinases such as MMP9; matrixmetalloproteinase inhibitors such a TIMP-1; and combinations thereof.For example but not by way of limitation, a prostate cancer assay maymeasure PSA as a cancer cell type biomarker, and measure a ratio ofPAI-1/PSA for metastatic potential.

Any chemo resistance biomarkers known in the art or otherwisecontemplated herein may be utilized in accordance with the presentlydisclosed and/or claimed inventive concept(s). In certain embodiments,the chemo resistance biomarker is a biomarker that detects theprevention of cell death (apoptosis), for example but not by way oflimitation, a detection of the presence of a cancer stem cell biomarker,such as but not limited to, PL2L piwi like, ADLH, β-integrin, α6integrin, c-kit, c-met, LIF-R, CXCR4, ESA, CD 20, CD44, CD133, CK5,TRAF2 and ABC transporters. In another non-limiting example, cancercells that contain CD44 but lack CD24 are indicative of a cancer stemcell phenotype. Also, cancer cells that lack CD45 and CD31 but containCD34 are indicative of a cancer stem cell. Also, cancer cells thatcontain CD44 and CD24 as well as ESA are indicative of a cancer stemcell. Further, the presence of both CD24 and ESA are indicative of acancer stem cell. Somatic stem cells in solid tumor carcinomas canbecome cancer stem cells. Other cancer cells resistant to CD95induced-apoptosis are chemo resistant. Cancer stem cells are chemoresistant in nature, and contain a capacity for self renewal (asymmetricdivisions) as well as being capable of differentiation into a hierarchyof progeny cells to form a tumor. Cancer stem cell self renewal isactivated by the stem cell signaling pathways (Wnt, Sonic Hedge hog andNotch) and at the epigenetic level by Polycomb gener (BMI-1 and EZH2).This self renewal occurs at the expense of apopotosis signaling pathways(Caspase 3, 5, 8, p53). Measuring cancer stem cell biomarkers andcombinations thereof as an indication of chemo resistance provides ameasure of (a) drug resistance, (b) the inability to activate apoptosis,and/or (c) the inability to shutdown self renewal.

The probes described and claimed herein may be labeled by any methodsknown in the art or otherwise contemplated herein. For example, but notby way of limitation, the labels of the first, second and third (and anyadditional fourth, fifth, sixth, etc.) labeled probes may be selectedfrom a comprehensive catalogue of fluorescent (luminescent) dyes. Forexample but not by way of limitation, a comprehensive catalogue existsonline at http://www.fluorophores.org (the entire contents of which areexpressly incorporated herein by reference). This catalogue includescommonly used labels such as fluorescein-5-isothiocyanate (FITC),phycoerythrin, sulforhodamine 101 (Texas Red),2-[4-(aminoiminomethyl)phenyI]-1H-Indole-6-carboximidamide (DAPI),3H-Indolium (Cy5), 1H-benz[e]indolium (Cy 5.5), 3H-Indolium (Cy 7),ALEXA FLUOR® 488, ALEXA FLUOR® 555, ALEXA FLUOR® 647, and combinationsand derivatives thereof that have been synthesized in order to providebetter reagents. Additionally, rare earth metals and rare earthelement-containing nanoparticles can be used as labels.

The biological samples utilized in the methods of the presentlydisclosed and/or claimed inventive concept(s) may be utilized in theform they are obtained (i.e., tissue sample), or they may be exposed toone or more isolating steps (i.e., isolation of cancer cells therefrom).

While the assays described herein above describe the measurement ofthree biomarkers with three labeled probes, it is to be understood thatone or more additional biomarker(s) may also be measured in the assay(utilizing additional one or more additional labeled probe(s)). Forexample, but not by way of limitation, the assay may further includemeasuring at least one additional biomarker in the biological sampleutilizing a fourth labeled probe that binds to said additionalbiomarker, measuring a second additional biomarker in the biologicalsample utilizing a fifth labeled probe that binds to said additionalbiomarker, measuring a third additional biomarker in the biologicalsample utilizing a sixth labeled probe that binds to said additionalbiomarker, etc. Ideally, a maximum of six to eight labeled probes areutilized; otherwise, it is difficult to detect all of the labeled probesat different, non-overlapping excitations and emission wavelengths.

These additional biomarkers may include biomarkers that detect othercellular properties, specifically the presence of cell nuclei or ofintact cell membranes, for the cells that are positive for the cancercell type biomarker. For example but not by way of limitation, thepresence of cell nuclei may be detected utilizing a DNA binding probesuch as but not limited to, DAPI. In another non-limiting example, thedetection of intact cell membranes may involve the detection of anionicphospholipids (such as but not limited to, phosphatidylserine) on thesurface of cells, and the second labeled probe may bebis(zinc2+dipicolylamine) and/or PSVue™.

The one or more additional biomarker(s)/labeled probe(s) may also beutilized to reduce any false positive results obtained with the cancercell type biomarker; for example but not by way of limitation, whiteblood cells may be excluded from the assay by excluding cells positivefor one or more markers of cluster of differentiation (also referred toas “cluster of designation”; often abbreviated as CD). For example butnot by way of limitation, markers such as CD45, CTLA-4, CD4, CD68 and/orCD8 present on white blood cells can be used to indicate that a cell isnot a cancer cell. In a particular non-limiting example, CD45 antigen(also known as PTPRC, Protein tyrosine phosphatase receptor type C, andoriginally called leukocyte common antigen (all terms used hereininterchangeably)) is useful in detecting all white blood cells.Additionally, CD45 can be used to differentiate the different types ofwhite blood cells when combined with other CD markers. For example,granulocytes are indicated by CD45+, CD15+; monocytes are indicated byCD45+, CD14+; T lymphocytes are indicated by CD45+, CD3+; T helper cellsare indicated by CD45+, CD3+, CD4+; cytotoxic T cells are indicated byCD45+, CD3+, CD8+; B lymphocytes are indicated by CD45+, CD19+or CD45+,CD20+; thrombocytes are indicated by CD45+, CD61+; and natural killercells are indicated by CD16+, CD56+, CD3−. Additionally, two commonlyused CD molecules are CD4 and CD8, which are, in general, used asmarkers for helper and cytotoxic T cells, respectively. These moleculesare defined in combination with CD3+, as some other leukocytes alsoexpress these CD molecules (some macrophages express low levels of CD4;dendritic cells express high levels of CD8).

The presently disclosed and/or claimed inventive concept(s) is alsodirected to a kit that includes the first, second and third labeledprobes (that bind to a cancer cell type biomarker, a chemo resistancebiomarker, and a metastatic potential biomarker, respectively) asdescribed in detail herein above. Additional labeled probes fordetecting other biomarkers as further described herein above may also beincluded in the kit. All of the labeled probes present in the kit aremeasured at different excitations and emission wavelengths.

The kit may also include means for isolating cancer cells from abiological sample. Said means are well known in the art (see forexample, Lianidou and Markou, 2011; the entire contents of which arehereby expressly incorporated herein by reference); therefore, noadditional discussion thereof is deemed necessary.

The presently disclosed and/or claimed inventive concept(s) is alsodirected to methods of (1) monitoring cancer treatment in a cancerpatient undergoing said treatment, and (2) monitoringprogression/relapse of the disease in the cancer patient. In the methodof (1) monitoring cancer treatment, a first biological sample isobtained from the patient prior to exposure to a cancer treatment, and asecond biological sample is obtained from the patient following exposureto the cancer treatment. In the method of (2) monitoringprogression/relapse of disease, the first biological sample is obtainedfrom the patient at a first time point, and the second biological sampleis obtained from the patient at a subsequent time point. In bothmethods, the levels of a cancer cell type biomarker (as described hereinabove), a chemo resistance biomarker (as described herein above), and ametastatic potential biomarker (as described herein above) are thenmeasured utilizing first, second and third labeled probes, respectively(as described in detail herein above), in the first and secondbiological samples. The cells to which the first labeled probe is boundare identified in the first and second biological samples, and then thelevels of (i) the chemo resistance biomarker and (ii) the metastaticpotential marker in the cells to which the first labeled probe is boundare compared in the first and second biological samples. It is thendetermined in the method of (1) that the cancer treatment is effectiveif the level of the chemo resistance biomarker is decreased and thelevel of the metastatic potential biomarker is increased in the secondbiological sample when compared to the first biological sample;alternatively, it is then determined in the method of (2) that thecancer has progressed/relapsed if the level of the chemo resistancebiomarker is increased and the level of the metastatic potentialbiomarker has decreased in the second biological sample when compared tothe first biological sample.

The biological samples utilized in the methods of the presentlydisclosed and/or claimed inventive concept(s) may be utilized in theform they are obtained (i.e., tissue sample), or they may be exposed toone or more isolating steps (i.e., isolation of cancer cells therefrom).

While the methods described herein above describe the measurement ofthree biomarkers with three labeled probes, it is to be understood thatadditional biomarkers may also be included in the methods (utilizingadditional labeled probes). For example, but not by way of limitation,the method may further include measuring at least one additionalbiomarker in the first and second biological samples utilizing a fourthlabeled probe that binds to said additional biomarker, measuring asecond additional biomarker in the first and second biological samplesutilizing a fifth labeled probe that binds to said additional biomarker,measuring a third additional biomarker in the first and secondbiological samples utilizing a sixth labeled probe that binds to saidadditional biomarker, etc. Ideally, a maximum of six to eight labeledprobes are utilized; otherwise, it is difficult to detect all of thelabeled probes at different, non-overlapping excitations and emissionwavelengths. When additional biomarkers are measured, the methods mayalso include the step of comparing the levels of the additionalbiomarker(s) in the cells to which the first labeled probe is bound inthe first and second biological samples.

These additional biomarkers may include biomarkers that detect othercellular properties, specifically the presence of cell nuclei or ofintact cell membranes, for the cells that are positive for the cancercell type biomarker. For example but not by way of limitation, thepresence of cell nuclei may be detected utilizing a DNA binding probesuch as but not limited to, DAPI. In another non-limiting example, thedetection of intact cell membranes may involve the detection of anionicphospholipids (such as but not limited to, phosphatidylserine) on thesurface of cells, and the second labeled probe may bebis(zinc2+dipicolylamine) and/or PSVue™.

The one or more additional biomarker(s)/labeled probe(s) may also beutilized to reduce any false positive results obtained with the cancercell type biomarker; for example but not by way of limitation, whiteblood cells may be excluded from the methods by excluding cells positivefor one or more markers of cluster of differentiation (as described indetail herein above).

EXAMPLES

Examples are provided hereinbelow. However, the presently disclosedand/or claimed inventive concept(s) is to be understood to not belimited in its application to the specific experimentation, results andlaboratory procedures. Rather, the Examples are simply provided as oneof various embodiments and are meant to be exemplary, not exhaustive.

Example 1 Multiplexed Assay for Breast Cancer

The following procedure shows the multiplexing of Biomarkers A (cancercell type), B (metastatic potential) and C (chemo resistance) using aunique combination of affinity reagents with fluorescent labels and anaffinity label to provide a multiplexed assay for breast cancer. Thisallows the simultaneous measurement of cancer cell type, chemoresistance nature, and metastatic potential, as described herein above,in combination with a marker indicating the presence of cell nucleus(utilizing a nucleic acid binding probe). The data demonstrated thatfour simultaneous signals can be measured with this combination but notwith the traditional combinations of the prior art. The presentlydisclosed and/or claimed inventive concept(s) has the potential tomeasure up to eight signals utilizing various fluorophores taughtherein.

The procedure to test the method was to collect 4 mL normal whole bloodfresh into a VACUTAINER® tube (BD 6 mL VACUTAINER° K2EDTA tube, 10.8 mg,ref 367863, Becton Dickinson, Oakville, ON) and transfer the blood intoa round centrifuge tube sealed with top. Cancer cells were added by 40μL of breast cell cancer suspension to obtain a range of 3000 to 8000cells/mL (8 cells/μL or 1-2 per high powered filed HRP (HRP=0.2 μL)).The blood was lysed by adding 3 mL of lysis buffer (155 mM NH₄Cl, 20 mMKHCO₃, 0.1 mM Na₂EDTA, pH 7.4). The tubes were rolled tubes to assurethat the cells were evenly distributed and that lysis was complete, andthen the sample was spun down for 15 minutes at 12,000 rpm. Next, theplasma was decanted as waste supernatant, and 4.0 mL of TES buffer (50mM N-Tris [Hydroxymethyl]-2-aminoethane-sulfonic acid: TES, pH 7.4, 2150mM NaCl, 2 mM MgSO₄ and 1 mM KCO₃) and 1% albumin was added, and thetube was rocked to mix the cells. The tube was spun down again for 15minutes at 12,000 rpm, and the supernatant was decanted as waste. Afinal 2.0 mL of TES wash buffer was added with rocking to mix cells.

The cells were then reacted with the reagents by taking 0.5 mL of washedblood to the centrifuge tube, and 40 μL of antibodies for HER2/neulabeled with Cy5 and 40 μL of antibodies for urokinase like plasminogenactivator (uPA) or plasminogen activator inhibitor (PAI-1) labeled withTexas Red (at working stock of 0.001 to 0.1 mg/mL) and PL2L piwi likelabeled with FITC (at working stock of 0.001 to 0.1 mg/mL) were added.Next, 10 μl of a 100 μg/ml 4,6 Diamidino-2-phenylindole dihydrochloride(DAPI; a nucleic acid binding probe) was added from a solution in TESbuffer. This was followed by incubation for 15 minutes at 37° C.

The sample was centrifuged down for 5 minutes @7500 rpm, and thesupernatant was decanted off as waste (^(˜)450 μL). 500 μL of TES bufferwas then added, and the sample was vortexed and centrifuged down at 5minutes @7500 rpm. Again, the supernatant was decanted off by tapping aswaste (^(˜)450 μL). A final 500 μL of TES wash buffer was added forfinal imaging, and 5 μL of the solution was placed on a slide with along cover slip of glass. Phase contrast and fluorescence microscopy wasconducted with the Leica DM5000 (Leica Microsystems, Buffalo Grove,Ill.). A sample of cells was stained with the PSS-550 probe (ex 553, em615 nm) and measured with an excitation band pass filter at 540-580 nmand an emission band pass filter at 610-680 nm to determine cellmembrane flopping as a measure of cell death in addition to cell counts.

The Texas Red label (ex 592, em 614 nm) was measured with an excitationband pass filter at 540-580 nm and an emission band pass filter at610-680 nm. The FITC label (ex 488, em 525 nm) was measured with anexcitation band pass filter at 460-500 nm and an emission band passfilter at 512-543 nm. The DAPI probe (ex 355, em 460 nm) was measuredwith an excitation band pass filter at 340-380 nm and an emission bandpass filter at 450-490 nm. The Cy5 label (ex 646, em 676 nm) wasmeasured with an excitation band pass filter at 590-650 nm and anemission band pass filter at 665-735 nm.

The ideal multiplexing was demonstrated by combination of the rare earthnanoparticles with FITC, Texas Red, Cy5 and DAPI. The europiumnanoparticle (ex 355, em 617 nm) was measured at an excitation filterband pass at 340-380 nm and emission long pass filter of >590 nm.Simultaneously measuring biomarkers for cancer cell type, metastaticpotential and chemoresistance, along with a biomarker indicating thepresence of cell nucleus was possible, along with the removal of falsepositives (i.e., white blood cells) by detecting the presence of thebiomarker CD45. Current data allows for five signals. However, theassays/methods described and claimed herein have the potential fordetection and measurement of six signals/biomarkers, if the rare earthnanoparticles can be multiplexed into three different emission signals.The europium label greatly increased signal over FITC and Texas Red by2-3 orders of magnitude.

Example 2 Cell Response Assay for Breast Cancer

A novel cell response assay for breast cancer was developed by usingHER2/neu as a tissue type marker for carcinoma breast cancer (BiomarkerA) that is always present in the disease state. Biomarker B formetastatic potential utilized uPA and PAI antigen; these are markers oftumor invasiveness and are present in aggressive cancer celldifferentiation and growth and increase with metastatic invasivenesspotential of the cells. Biomarker C for chemo resistance utilized PL2Lpiwi like antigen (see for example, Gao et al., 2008).

The procedure shown in Example 1 was used to measure cancer cells beforeand after treatment with and without camptothecin. Camptothecin is knownto activate apoptosis in cancer cells and kill cancer cells like achemotherapy agent (See Gupta, 1997). Cells were tested by the cellresponse assay and by a traditional prior art assay. The novel “cellresponse assay” utilized HER2/neu as Biomarker A for cell type, thetumor invasiveness markers uPA & PAI-1 as Biomarker B for metastaticpotential, and the cancer stem cell marker PL2L piwi like as Biomarker Cfor chemo resistance nature. The traditional assay used EpCAM as amarker for epithelial tissue type and cytokeratin (CK) as a marker ofcells of cancer origin. Additionally, CD45, a marker for white bloodcells, was used to reduce false results, with CD45 positive resultsbeing excluded from the analysis. Both the traditional and cell responseassays used DAPI to determine the presence of cell nuclei.

The camptothecin concentration could be adjusted to be sufficient tokill >80%, 60% and 40% of the cancer cells in cultures. Cellularanalysis showed cancer cell count to decrease as the cell death %increased and phosphatidylserine flopping increased. Cellular analysisshowed biomarker B, namely uPA and PA1, to increase (or was detected ina greater number of cancer cells) when the cell death % was highest.Cellular analysis showed biomarker C, namely PL2L piwi like to decrease(or was detected in a lesser number of cancer cells) when the cell death% was highest. All three biomarkers co-exist in the disease state andwere fundamental to progression or relapse of the disease. This analysisof the specific combination of biomarkers described and claimed hereinallows the determination of the cellular response to treatments bysimultaneously measuring cancer cell type, chemo resistance nature, andmetastatic potential (with or without the additional measurement of cellviability), and is herein termed a “cell based response assay”.

In contrast, in the traditional assay, the CD45 biomarker does notco-exist with EpCAM and CK. Both EpCAM and CK were present in all cellsindependent of the % of cells that were killed.

Example 3 Multiplexed Assay for Prostate Cancer

The following procedure shows the multiplexing of Biomarkers A (cancercell type), B (metastatic potential) and C (chemo resistance) using aunique combination of affinity reagents with fluorescent labels and anaffinity label to provide a multiplexed assay for prostate cancer. Thisallows the simultaneous measurement of cancer cell type, chemoresistance nature, and metastatic potential, as described herein above,in combination with a marker indicating the presence of cell nucleus(utilizing a nucleic acid binding probe). The data demonstrated thatfour simultaneous signals can be measured with this combination but notwith the traditional combinations of the prior art. The presentlydisclosed and/or claimed inventive concept(s) has the potential tomeasure up to eight signals utilizing various fluorophores taughtherein.

The procedure to test the method was to collect 4 mL normal whole bloodfresh into a VACUTAINER® tube (BD 6 mL VACUTAINER® K2EDTA tube, 10.8 mg,ref 367863, Becton Dickinson, Oakville, ON) and transfer the blood intoa round centrifuge tube sealed with top. Cancer cells were added by 40μL of prostate cell cancer suspension to obtain a range of 3000 to 8000cells/mL (8 cells/μL or 1-2 per high powered filed HRP (HRP=0.2 μL)).The blood was lysed by adding 3 mL of lysis buffer (155 mM NH₄Cl, 20 mMKHCO₃, 0.1 mM Na₂EDTA, pH 7.4). The tubes were rolled tubes to assurethat the cells were evenly distributed and that lysis was complete, andthen the sample was spun down for 15 minutes at 12,000 rpm. Next, theplasma was decanted as waste supernatant, and 4.0 mL of TES buffer (50mM N-Tris [Hydroxymethyl]-2-aminoethane-sulfonic acid: TES, pH 7.4, 2150mM NaCl, 2 mM MgSO₄ and 1 mM KCO₃) and 1% albumin was added, and thetube was rocked to mix the cells. The tube was spun down again for 15minutes at 12,000 rpm, and the supernatant was decanted as waste. Afinal 2.0 mL of TES wash buffer was added with rocking to mix cells.

The cells were then reacted with the reagents by taking 0.5 mL of washedblood to the centrifuge tube, and 40 μL of antibodies for PSA labeledwith Cy5 and 40 μL of antibodies for urokinase like plasminogenactivator (uPA) or plasminogen activator inhibitor (PAI-1) labeled withTexas Red (at working stock of 0.001 to 0.1 mg/mL) and PL2L piwi likelabeled with FITC (at working stock of 0.001 to 0.1 mg/mL) were added.Next, 10 μL of a 100 μg/ml 4,6 Diamidino-2-phenylindole dihydrochloride(DAPI; a nucleic acid binding probe) was added from a solution in TESbuffer. This was followed by incubation for 15 minutes at 37° C.

The sample was centrifuged down for 5 minutes @7500 rpm, and thesupernatant was decanted off as waste (^(˜)450 μL). 500 μL of TES bufferwas then added, and the sample was vortexed and centrifuged down at 5minutes @7500 rpm. Again, the supernatant was decanted off by tapping aswaste (^(˜)450 μL). A final 500 μL of TES wash buffer was added forfinal imaging, and 5 μL of the solution was placed on a slide with along cover slip of glass. Phase contrast and fluorescence microscopy wasconducted with the Leica DM5000 (Leica Microsystems, Buffalo Grove,Ill.).

The Texas Red label (ex 592, em 614 nm) was measured with a excitationband pass filter at 540-580 nm and emission band pass filter at 610-680nm. The FITC label (ex 488, em 525 nm) was measured with an excitationband pass filter at 460-500 nm and an emission band pass filter at512-543 nm. The DAPI probe (ex 355, em 460 nm) was measured with anexcitation band pass filter at 340-380 nm and an emission band passfilter at 450-490 nm. The Cy5 label (ex 646, em 676 nm) was measuredwith an excitation band pass filter at 590-650 nm and an emission bandpass filter at 665-735 nm.

The ideal multiplexing was demonstrated by combination of the rare earthnanoparticles with FITC, Texas Red, Cy5 and DAPI. The europiumnanoparticle (ex 355, em 617 nm) was measured at an excitation filterband pass at 340-380 nm and emission long pass filter of >590 nm.Simultaneously measuring biomarkers for cancer cell type, metastaticpotential and chemoresistance, along with a biomarker indicating thepresence of cell nucleus was possible, along with the removal of falsepositives (i.e., white blood cells) by detecting the presence of thebiomarker CD45. Current data allows for five signals. However, theassays/methods described and claimed herein have the potential fordetection and measurement of six signals/biomarkers, if the rare earthnanoparticles can be multiplexed into three different emission signals.The europium label greatly increased signal over FITC and Texas Red by2-3 orders of magnitude.

Example 4 Cell Response Assay for Prostate Cancer

Protease, like plasmin, is expressed during metastasis of malignantcells as part of the tissue regeneration and fibrinolysis process,indirectly promoting cell proliferation. Cancer cells use cell-boundplasmin to activate the plasminogen signaling for urokinase. Inhibitorsof plasmin such as Bikunin and inhibitors of plasminogen activation suchas PAI-1 prevent cell-bound plasmin activation and suppress tumorinvasiveness.

A novel cell response assay for prostate cancer was developed by usingPSA as a tissue type marker for prostate carcinoma (Biomarker A) that isalways present in the disease state. The markers used in this examplefor metastatic potential (Biomarker B) were urokinase plasminogenactivator (uPA) and plasminogen activator inhibitor (PAI-1), which is ameasure of tissue invasiveness and is present in an aggressive cancercell differentiation and growth with increased metastatic invasivenesspotential. Chemo resistance nature (Biomarker C) was determined usingPL2L piwi like antigen to determine the inhibitory response to tissueinvasiveness.

The procedure shown in Example 3 was used to measure prostate cancercells before and after treatment with and without camptothecin.Camptothecin is known to activate apoptosis in cancer cells and killcancer cells like a chemotherapy agent (See Gupta, 1997). Cells weretested by the cell response assay and by a traditional prior art assay.The novel “cell response assay” utilized PSA as Biomarker A for celltype, the tumor invasiveness markers uPA & PAI-1 as Biomarker B formetastatic potential, and the cancer stem cell marker PL2L piwi like asBiomarker C for chemo resistance nature. The traditional assay usedEpCAM as a marker for epithelial tissue type and cytokeratin (CK) as amarker of cells of cancer origin. Additionally, CD45, a marker for whiteblood cells, was used to reduce false results, with CD45 positiveresults being excluded from the analysis. Both the traditional and cellresponse assays used DAPI to determine the presence of cell nuclei.

The camptothecin concentration could be adjusted to be sufficient tokill >80%, 60% and 40% of the cancer cells in cultures. Cellularanalysis showed cancer cell count to decrease as the cell death %increased and phosphatidylserine flopping increased. Cellular analysisshowed biomarker B, namely uPA and PA1, to increase (or was detected ina greater number of cancer cells) when the cell death % was highest.Cellular analysis showed biomarker C, namely PL2L piwi like to decrease(or was detected in a lesser number of cancer cells) when the cell death% was highest. All three biomarkers co-exist in the disease state andwere fundamental to progression or relapse of the disease. This analysisof the specific combination of biomarkers described and claimed hereinallows the determination of the cellular response to treatments bysimultaneously measuring cancer cell type, chemo resistance nature, andmetastatic potential (with or without the additional measurement of cellviability), and is herein termed a “cell based response assay.”

In contrast, in the traditional assay, the CD45 biomarker does notco-exist with EpCAM and CK. Both EpCAM and CK were present in all cellsindependent of the % of cells that were killed.

Example 5

The following procedure demonstrates the multiplexing of Biomarkers A, Band C as described herein previously to provide a general assay for alltypes of cancers. This procedure is performed as described herein abovein Examples 1/3, except as follows: (a) the cancer suspension added tothe procedure is selected from one of the following cell lines—SKBR, MCFor MDA (breast cancer), UC3 or T24 (bladder cancer), PC3-9 (prostatecancer), and A549 (lung cancer); and (b) the non-specific cancer cellbiomarker cytokeratin is utilized for Biomarker A. In this particularexample, antibodies to the cytokeratins 8/18/19 (wherein said antibodiesare labeled with Cy5) are utilized as the first labeled probe that bindsto Biomarker A. As described in Examples 1 and 3, antibodies to uPA orPAI-1 labeled with Texas Ted are utilized as the second labeled probethat binds to Biomarker B, and antibodies to PL2L piwi like labeled withFITC is utilized as the third labeled probe that binds to Biomarker C.The nucleic acid binding probe DAPI is also utilized as described inExamples 1 and 3.

This multiplexed assay utilizing a non-specific cancer cell biomarkerallows the assays/methods described herein to be adapted for use withall types of cancers.

Thus, in accordance with the presently disclosed and/or claimedinventive concept(s), there has been provided a cell response assay, aswell as methods of producing and using same, that fully satisfies theobjectives and advantages set forth hereinabove. Although the presentlydisclosed and/or claimed inventive concept(s) has been described inconjunction with the specific drawings, experimentation, results andlanguage set forth hereinabove, it is evident that many alternatives,modifications, and variations will be apparent to those skilled in theart. Accordingly, it is intended to embrace all such alternatives,modifications and variations that fall within the spirit and broad scopeof the presently disclosed and/or claimed inventive concept(s).

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The following references, to the extent that they provide exemplaryprocedural or other details supplementary to those set forth herein, arespecifically incorporated herein by reference in their entirety.

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U.S. Pat. No. 5,834,196

U.S. Pat. No. 7,179,616

What is claimed is:
 1. A method of monitoring cancer treatment in acancer patient undergoing said treatment, wherein the treatment ismonitored using a multiplexed direct affinity assay, and wherein themethod comprises the steps of: (A) isolating cells from a firstbiological sample taken from a cancer patient at a first time point; (B)isolating cells from a second biological sample taken from a cancerpatient at a second time point, wherein the cancer patient has beenexposed to a cancer treatment between the first and second time points;(C) reacting the isolated cells from the first biological sample with atleast three affinity reagents for biomarkers, wherein the isolated cellsare reacted with the at least three affinity reagents in a singlereaction, wherein each affinity reagent comprises a differentfluorescent label whereby the different fluorescent labels are measuredat different excitations and emissions wavelengths, and wherein the atleast three biomarkers comprise: (i) a cancer cell type biomarker; (ii)a metastatic potential biomarker; and (iii) a chemo resistancebiomarker; wherein biomarkers (i), (ii), and (iii) all co-exist in thecancer disease state, are fundamental to progression or relapse of thecancer disease state, and are all biochemically linked in a biochemicalprocess; and wherein the presence of markers (ii) and (iii) are linkedsuch that the presence of one facilitates absence of the other; (D)reacting the isolated cells from the second biological sample with theat least three affinity reagents of (C), wherein the isolated cells arereacted with the at least three affinity reagents in a single reaction;(E) simultaneously measuring, in a multiplexed assay, expression levelsof the at least three biomarkers in the isolated cells from the firstbiological sample; (F) simultaneously measuring, in a multiplexed assay,the expression levels of the at least three biomarkers in the isolatedcells from the second biological sample; (G) calculating a proportion ofcells detected by the cancer cell type biomarker that are also detectedby the metastatic potential biomarker in the first and second biologicalsamples; (H) calculating a proportion of cells detected by the cancercell type biomarker that are also detected by the chemo resistancebiomarker in the first and second biological samples; and (I)determining that the cancer patient is responding to treatment if: (1)the metastatic potential biomarker is present in a greater proportion ofcancer cells detected by the cancer cell type biomarker in the secondbiological sample when compared to the first biological sample; and (2)the chemo resistance biomarker is present in a lesser proportion ofcancer cells detected by the cancer cell type biomarker in the secondbiological sample when compared to the first biological sample; ordetermining that the cancer is progressing and/or relapsing if (1) and(2) are not present.
 2. The method of claim 1, wherein the cancerpatient is suffering from a cancer selected from the group consisting oflung, bronchus, colon, rectum, pancreas, prostate, breast, liver, bileduct, bladder, ovary, brain, central nervous system (CNS), kidney,pelvis, uterine corpus, oral cavity, pharynx, melanoma, and combinationsthereof.
 3. The method of claim 1, wherein the at least one cancer celltype biomarker is selected from the group consisting of epithelial celladhesion molecule (EpCAM), a cytokeratin, vimentin, galectin-3, acadherin, an oncoprotein, an oncogene, and combinations thereof.
 4. Themethod of claim 3, wherein the at least one cancer cell type biomarkercomprises at least one of: (a) a combination of at least one type Icytokeratin and at least one type II cytokeratin; (b) a combination ofvimentin and galectin-3; and (c) a combination of N-cadherin andE-cadherin.
 5. The method of claim 3, wherein the oncoprotein/oncogeneis selected from the group consisting of HER2/neu, VEGF-165, KRAS, EGFr,WAF, BAX-1, PDGF, Rb, Jagged 1, Notch, VEGF, VEGHR, k-Ras, CAIX, MIB1,MDM, PR, ER, SEL5, SEM1, PI3K, Akt2, twist 1, EML-4, ALK, Braf, DRAFF,c-met, and combinations thereof.
 6. The method of claim 1, wherein atleast one of: (a) the patient is suffering from prostate cancer, and theat least one cancer cell type biomarker comprises at least one ofprostate specific antigen (PSA), prostate specific membrane antigen(PSMA), and combinations thereof; (b) the patient is suffering frombreast cancer, and the at least one cancer cell type biomarker comprisesat least one of MUC1, CA 15-3, CA 27-29, and combinations thereof; (c)the patient is suffering from colon cancer, and the at least one cancercell type biomarker comprises at least one of Carcinoembryonic Antigen(CEA), CA19-9, Galactosyl Transferase II, and combinations thereof; (d)the patient is suffering from pancreatic cancer, and the at least onecancer cell type biomarker comprises MSLN (mesothelin); (e) the patientis suffering from ovarian cancer, and the at least one cancer cell typebiomarker comprises at least one of CA 125, Follicle-Stimulating Hormone(FSH) receptor, and combinations thereof; (f) the patient is sufferingfrom liver cancer, and the at least one cancer cell type biomarkercomprises Alpha-Fetoprotein; (g) the patient is suffering from melanoma,and the at least one cancer cell type biomarker comprises at least oneof Melan-A (MLANA), Tyrosinase (TYR), CSPG4, MITF and combinationsthereof; and (h) the patient is suffering from thyroid cancer, and theat least one cancer cell type biomarker comprises at least one ofParathyoid related protein (PTHP), TSHR, and combinations thereof. 7.The method of claim 1, wherein the at least one chemo resistancebiomarker comprises a cancer stem cell biomarker.
 8. The method of claim7, wherein the at least one chemo resistance biomarker is selected fromthe group consisting of PL2L piwi like, ADLH, beta-integrin,alpha-6-integrin, c-kit, c-met, LIF-R, CXCR4, ESA, CD 20, CD44, CD133,CKS, TRAF2, ABC transporters, and combinations thereof.
 9. The method ofclaim 7, wherein the at least one chemo resistance biomarker comprisesat least one of: (a) presence of CD44 and absence of CD24; (b) presenceof CD34 and absence of CD45 and CD31 (c) presence of CD44, CD24, andESA; and (c) presence of CD24 and ESA.
 10. The method of claim 1,wherein the at least one metastatic potential biomarker is selected fromthe group consisting of urokinase plasminogen activator (uPA),plasminogen activator inhibitor (PAI-1), CD95, a serine protease, aserine protease inhibitor, a matrix metalloproteinase, a matrixmetalloproteinase inhibitor, and combinations thereof.
 11. The method ofclaim 10, wherein at least one of: (a) the serine protease is selectedfrom the group consisting of plasmin, ADAM, and combinations thereof;(b) the serine protease inhibitor comprises Bikunin; (c) the matrixmetalloproteinase comprises MMP9; and (d) the matrix metalloproteinaseinhibitors comprises TIMP-1.
 12. The method of claim 1, wherein at leastone of the affinity reagents comprises a conjugate of a fluorescentlabel to an antibody to the biomarker.
 13. The method of claim 1,wherein the labels of the first, second, and third labeled probes areselected from the group consisting of fluorescein-5-isothiocyanate(FITC), phycoerythrin, sulforhodamine 101(Texas Red),2-[4-(aminoiminomethyl)phenyi]-1H-Indole-6-carboximidamide (DAPI),3H-Indolium (Cy5), 1H-benz[e]indolium (Cy 5.5), 3H-Indolium (Cy 7),ALEXA FLUOR® 488, ALEXA FLUOR® 555, ALEXA FLUOR® 647, rare earth metals,rare earth element-containing nanoparticles, and combinations andderivatives thereof.
 14. The method of claim 1, wherein the biologicalsample is further defined as a tissue sample.
 15. The method of claim 1,wherein at least four biomarkers are simultaneously measured, whereinthe fourth biomarker comprises at least one of: (a) at least one whiteblood cell biomarker selected from the group consisting of CD45, CTLA-4,CD4, CD68, CD8, and combinations thereof, and wherein the method furthercomprises the step of excluding cells positive for at least one whiteblood cell biomarker from the calculating steps; (b) a biomarkerindicating the presence of cell nuclei, and wherein the fourth labeledprobe comprises 4′,6-diamidino-2′-phenylindole, dihydrochloride (DAPI);and (c) phosphatidylserine, and wherein the fourth labeled probecomprises at least one of bis(zinc²+dipicolylamine) and PSVue™.
 16. Themethod of claim 1, wherein the method is further defined as a method ofmonitoring breast cancer treatment, and wherein biomarker (i) isHER2/neu, biomarker (ii) is uPA and PAI-1, and biomarker (iii) is PL2Lpiwi like.
 17. The method of claim 1, wherein the method is furtherdefined as a method of monitoring prostate cancer treatment, and whereinbiomarker (i) is PSA, biomarker (ii) is uPA and PAI-1, and biomarker(iii) is PL2L piwi like.
 18. A method of monitoring cancer treatment ina cancer patient undergoing said treatment, wherein the treatment ismonitored using a multiplexed direct affinity assay, and wherein themethod comprises the steps of: (A) isolating cells from a firstbiological sample taken from a cancer patient at a first time point; (B)isolating cells from a second biological sample taken from a cancerpatient at a second time point, wherein the cancer patient has beenexposed to a cancer treatment between the first and second time points;(C) reacting the isolated cells from the first biological sample with atleast three affinity reagents for biomarkers, wherein the isolated cellsare reacted with the at least three affinity reagents in a singlereaction, wherein each affinity reagent comprises a differentfluorescent label whereby the different fluorescent labels are measuredat different excitations and emissions wavelengths, and wherein the atleast three biomarkers comprise: (i) a cancer cell type biomarker; (ii)a metastatic potential biomarker; and (iii) a chemo resistancebiomarker; wherein biomarkers (i), (ii), and (iii) all co-exist in thecancer disease state, are fundamental to progression or relapse of thecancer disease state, and are all biochemically linked in a biochemicalprocess; and wherein the presence of markers (ii) and (iii) are linkedsuch that the presence of one facilitates absence of the other; (D)reacting the isolated cells from the second biological sample with theat least three affinity reagents of (C), wherein the isolated cells arereacted with the at least three affinity reagents in a single reaction;(E) simultaneously measuring, in a multiplexed assay, expression levelsof the at least three biomarkers in the isolated cells from the firstbiological sample; (F) simultaneously measuring, in a multiplexed assay,the expression levels of the at least three biomarkers in the isolatedcells from the second biological sample; (G) calculating a proportion ofcells detected by the cancer cell type biomarker that are also detectedby the metastatic potential biomarker in the first and second biologicalsamples; (H) calculating a proportion of cells detected by the cancercell type biomarker that are also detected by the chemo resistancebiomarker in the first and second biological samples; and (I)administering a subsequent dose of the cancer treatment if: (1) themetastatic potential biomarker is present in a greater proportion ofcancer cells detected by the cancer cell type biomarker in the secondbiological sample when compared to the first biological sample; and (2)the chemo resistance biomarker is present in a lesser proportion ofcancer cells detected by the cancer cell type biomarker in the secondbiological sample when compared to the first biological sample.
 19. Themethod of claim 18, wherein the method is further defined as a method ofmonitoring breast cancer treatment, and wherein biomarker (i) isHER2/neu, biomarker (ii) is uPA and PAI-1, and biomarker (iii) is PL2Lpiwi like.
 20. The method of claim 18, wherein the method is furtherdefined as a method of monitoring prostate cancer treatment, and whereinbiomarker (i) is PSA, biomarker (ii) is uPA and PAI-1, and biomarker(iii) is PL2L piwi like.